Targeted care program improves engagement, HIV suppression in female sex workers

An HIV and sexual health intervention conducted among female sex workers in Zimbabwe appears to have increased engagement in health services and reduced the proportion of women with detectable viral loads, according to late-breaking data presented at AIDS 2016.

Despite this, a recent trial intensifying the interventions offered through the program did not result in further reductions in viral load proportions, Frances Cowan, MD, FRCPE, professor of international sexual health and HIV at University College London, said at the meeting.

“Sex workers in Africa bear the brunt of the HIV epidemic,” Cowan said during a press conference. “They have prevalences in the range of 50% to 70% and very high incidence rates. We also know they’re very poorly linked to prevention and care services when you compare them to the rest of the population, [but] we know that services led by sex workers that are community-based are the ones most likely to result in improvements in care and prevention.”

Expanded program offers no additional improvement

The Zimbabwean “Sisters” program has provided free HIV testing, contraception, STD care, education, ART recommendations and peer support to female sex workers since 2009. In the SAPPH-IRe study, Cowan and colleagues expanded these services to offer onsite ART, text reminders to promote HIV testing, pre-exposure prophylaxis and additional community-based adherence. After recording baseline HIV rates and viral loads, they matched women receiving the expanded care to those enrolled in the standard “Sisters” program and gauged a number of outcomes. These included health care involvement, delivery of services and the proportion of participants with viral loads greater than 1,000 copies/mL.

At baseline, 57.5% of the 2,722 enrolled sex workers had HIV, and 50.5% had HIV and viral loads exceeding the 1,000 copies/mL cutoff. Among the 2,883 workers surveyed 21 months after entering the programs, 19% of “Sisters” participants and 16% of SAPPH-IRe participants had HIV and viral loads exceeding the cutoff.

These findings show that both programs reduced rates of viremia within female sex workers, Cowan said, despite there being no significant difference between the standard and expanded programs. Beyond these primary outcomes, the researchers reported increases in attendance, on-site therapy initiations, testing and peer-mediation meetings through the expanded program.

“It seems that intervening with these programs can help engage [female sex workers] in care, and improve their own health and the likelihood that they might infect other people,” Cowan said.

Barriers to HIV services remain for many at-risk groups

Female sex workers represent just one of the several at-risk demographics requiring increased care, Chris Beyrer, MD, MPH, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health and president of the International AIDS Society (IAS), said during the same press event. Often, sex workers, men who have sex with men, transgender persons, people who inject drugs and prisoners each face discriminatory laws and policies that can limit their access to care and increase vulnerability to HIV, he said.

Chris Beyrer

“We will never be able to end AIDS without addressing the needs of the most vulnerable individuals and communities, and yet we know in 2016 far too many are being left behind,” Beyrer said at the conference. “Protecting human rights is not just a moral issue … it is also a scientific issue. Research presented at this conference is going to demonstrate that exclusion and discrimination can fuel the spread of HIV.”

Beyrer described recent data from UNAIDS, suggesting that these at-risk groups account for more than one-third of new HIV infections globally. Further, he said, transgender persons are nearly 50 times more likely to have HIV; MSM and injection drug users have a 24-fold increased risk for infection; sex workers are 10 times more likely to be infected; and prisoners are five times more likely to have HIV.

According to Beyrer and the other speakers — Edwin Cameron, LLB, justice of the Constitutional Court of South Africa — reducing these disparities will require focused efforts to curtail social stigmas and institutional barriers targeting these groups.

“Dealing effectively with HIV will require our communities and societies to break down long-standing prejudice, hatred and ignorance,” Cameron said in an IAS press release. “Only when scientific advances are matched by social and cultural progress can this epidemic truly be contained.” – by Dave Muoio

Reference:

Cowan F, et al. Abstract TUAX0103LB. Presented at: International AIDS Conference; July 18-22, 2016; Durban, South Africa.

Disclosure: Infectious Disease News was unable to determine relevant financial disclosures at the time of publication.